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It’s time for contraceptive justice

Clara Marks discusses the (lack of) research into male contraceptives.

In 1979, researchers in India first published that they were developing a form of hormonal male contraception, namely, ‘Reversible inhibition of sperm under guidance’ or RISUG. This non-surgical and reversible male contraception is injected into the vas deferens (the tubes transporting sperm from the testicle to the ejaculatory ducts). Over forty years on, RISUG is only just undergoing Phase 3 Clinical Trials.

In stark contrast, the female combined oral contraceptive pill was researched, tested, mass-produced and widely available on the market in the US by 1960. Why did it take fifty years for substantial research into hormone-based male contraceptives to even begin and why are there still no options available besides surgery and condoms?

The lack of non-surgical, long-term male contraceptive methods has real-life effects on women worldwide. UN data shows that 70% of global contraceptive users resort to female contraceptive methods over male ones. Even with surgical methods, available to both men and women, there is an imbalance – 23.7% of users were found to have had a hysterectomy or female tubal ligation while only 2% of users had a vasectomy.

In 2006, Phase 3 Clinical Trials of a combined testosterone and progestin male contraceptive by US pharmaceutical companies Organon and Schering were dropped when Bayer bought Schering. The pharmaceutical giant’s reasoning for stopping the trials is unclear, but a lack of interest could be inferred. TIME magazine quoted the deputy director as saying that “Once the acquisition was finalized, [Bayer] conducted a thorough review of the product portfolio to ensure that the business was investing resources in therapeutic areas that would bring the greatest benefits to patients while ensuring the company was operating in a financially responsible manner”. The subtext expresses the common myth that there is no demand for hormonal male contraceptives and thus, no profit to be made by companies in developing them.

The early studies showed side effects of acne, weight gain, and mood issues. Bayer, which as one of the top sellers of female birth control has profited from products with the same, if not worse, side effects, may struggle to claim that the medication lacked scientific precedent. Women taking the combined pill face significant side-effects: headaches, weight gain, mood changes, and decreased libido among others. The problem is that standards for safety are inconsistent and discriminatory.

Historically, pharmaceutical companies have been more likely to accept side effects caused by female contraception than male contraception. Alongside the medical burden caused by potential side-effects, women shoulder the financial burden of birth control. On average, female contraceptive methods are more expensive than male methods.

Just as there is little investment in making male contraceptive products, there is little investment into research about how men would react to new products entering the market, resulting in the unsubstantiated idea of a lack of interest remaining popular, despite no effort to prove or disprove it. However, recent research shows that there is a demand for equal access to contraception methods. A 2021 survey by 3Vraagt, as part of the EenVandaag opinion panels, found that 65% of 16–34-year-olds in the Netherlands believed the responsibility to avoid pregnancy should be shared equally by both partners. Responsibility would, of course, be much easier to share, if there were a readily available, reversible, non-surgical, hormone-based contraception method for men.

The Contraceptive Development Program’s (CDP) contraceptive skin gel shows promise in this respect. Much like the combined pill, it contains two main compounds: the progestin compound segesterone acetate, which makes the body believe it is making enough sperm and thus halt production, and testosterone to replace the low levels that progestin leads to. This maintains libido, and all men have to do is remember to rub the gel on their shoulders each morning, hardly more effort than the daily pill women ingest. However, progress is slow: speaking to IFLScience in January 2021, Dr Diana Blithe, Program Chief of the CDP, said that the gel would not be available in the next five years.

The rapid development of vaccines in recent years has shown us that with enough funding, time and energy, rapid development in scientific innovation is possible. In 2018, Global Market Insights valued the contraceptives market at $24,118.1 million in 2018 and estimated a growth of 6.9% from 2019 to 2025. There is evidently a financial profit to be made in this growing market, and pharmaceutical companies should push against unsubstantiated and outdated ideas about a lack of demand for long-term male contraception.

It’s time for contraceptive justice, which means men must take their share of responsibility after years of women enduring the financial and medical toll of birth control. The myth that pharmaceutical companies uphold about a lack of demand can only be countered by men stepping up and showing interest. Innovative and effective hormonal male contraception options could be readily available, but they will never reach the market unless apathy ends.

Image credit: Reproductive Heath Supplies Coalition/Unsplash

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